Global Perspectives on Cancer Health Disparities: Impact, Utility, and Implications for Cancer Nursing

Health and healthcare equity within the Canadian cancer care sector: a rapid scoping review

BACKGROUND

Despite a publicly-funded healthcare system, alarming cancer-related health and healthcare inequities persist in Canada. However, it remains unclear how equity is being understood and taken up within the Canadian cancer context. Our objective was to identify how health and healthcare equity are being discussed as goals or aims within the cancer care sector in Canada.

METHODS

A rapid scoping review was conducted; five biomedical databases, 30 multidisciplinary websites, and Google were searched. We included English-language documents published between 2008 and 2021 that discussed health or healthcare equity in the Canadian cancer context.

RESULTS

Of 3860 identified documents, 83 were included for full-text analysis. The prevalence of published and grey equity-oriented literature has increased over time (2008-2014 [n = 20]; 2015-2021 [n = 62]). Only 25% of documents (n = 21) included a definition of health equity. Concepts such as inequity, inequality and disparity were frequently used interchangeably, resulting in conceptual muddling. Only 43% of documents (n = 36) included an explicit health equity goal. Although a suite of actions were described across the cancer control continuum to address equity goals, most were framed as recommendations rather than direct interventions.

CONCLUSION

Health and healthcare equity is a growing priority in the cancer care sector; however, conceptual clarity is needed to guide the development of robust equity goals, and the development of sustainable, measurable actions that redress inequities across the cancer control continuum. If we are to advance health and healthcare equity in the cancer care sector, a coordinated and integrated approach will be required to enact transformative and meaningful change.

A scoping review documenting cancer outcomes and inequities for adults living with intellectual and/or developmental disabilities

INTRODUCTION

Emerging evidence suggests adults with intellectual and/or developmental disabilities (IDD) may be at risk of inequities in cancer experiences and outcomes. Individuals with IDD may experience multiple barriers that could worsen outcomes and experience. These barriers may be connected to features of IDD or the healthcare system overall. Future research and program planning to support adults with IDD and cancer must be informed by evidence that acknowledges potential disparities, underlying determinants, and knowledge deficits.

OBJECTIVE

We conducted a scoping review to systematically map the evidence describing and comparing cancer-related outcomes along the cancer continuum from risk to mortality for adults with IDD. We identified specific factors observed to influence those outcomes.

METHODS

We followed the expanded Arksey & O'Malley framework for conducting the scoping review. We searched for literature in PubMed and Embase databases. We abstracted cancer-related data, IDD-related data, and data related to physical and social determinants of health.

RESULTS

Of the 2796 studies retrieved, 38 were included for review. Most studies focused on screening outcomes and experiences. Studies reported that adults with IDD experienced inequities at various points along the cancer continuum. Numerous social and physical determinants of health influenced the experiences and outcomes of adults with IDD.

CONCLUSION

This scoping review identified significant gaps in the literature. Of note was the focus on cancer screening and lack of attention to larger systems of oppression that may influence poor cancer experiences and outcomes for adults with IDD. There is strong need to improve both quality and quantity of research in this area.

Essential oncology nursing care along the cancer continuum

Oncology nurses are at the heart of tackling the increasing global burden of cancer. Their contribution is unique because of the scale and the diversity of care roles and responsibilities in cancer care. In this Series paper, to celebrate the International Year of the Nurse and Midwife, we highlight the contribution and impact of oncology nurses along the cancer care continuum. Delivering people-centred integrated care and optimal communication are essential components of oncology nursing care, which are often played down. More oncology nurses using, doing, and leading research will further show the key nursing impact on care as part of a team. The oncology nurse influence in saving lives through prevention and early detection of cancer is noteworthy. Supportive care, the central pillar of oncology nursing, enables and empowers people to self-manage where possible. Globally, oncology nurses make a great positive difference to cancer care worldwide; their crucial contribution throughout the continuum of care warrants the inclusion and promotion of nursing in every country's cancer strategy. 2020 is the year of the nurse: let us take this learning to the future.

Scoping review protocol documenting cancer outcomes and inequalities for adults living with intellectual and/or developmental disabilities

INTRODUCTION

There is increasing attention on the cancer burden for adults with intellectual and developmental disabilities (IDD). Emerging evidence suggests there are differences in cancer experiences and outcomes for individuals living with IDD, from risk through survivorship. These differences may be attributed to features of the IDD, such as cognitive deficits and communication, as well as social determinants of health-like lower education levels and ableism. However, there is no comprehensive overview of the literature quantifying these potential disparities and describing the influencing factors. In this paper, we describe a scoping review protocol to systematically review published literature on cancer for adults with IDD. The purpose of this review is to identify differences in cancer risk, stage at diagnosis, treatment and survival along the cancer continuum for adults with IDD and outline potential contributing factors creating these disparities.

METHODS AND ANALYSIS

We will follow Arksey and O'Malley's expanded framework for scoping reviews to conduct this review. We will systematically search electronic databases for peer-reviewed, published journal articles to identify appropriate studies in collaboration with a health science librarian. Two reviewers will independently review titles and abstracts followed by a full-text review to determine whether it meets inclusion criteria. A data chart for collecting and sorting information will be developed in consultation with the team. Results will be collated and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews: PRISMA-Scoping Reviews. Extracted information will be summarised quantitatively and qualitatively to meet review objectives.

ETHICS AND DISSEMINATION

This scoping review will employ a methodology to identify literature related to cancer outcomes and experiences for adults with IDD. Results will be disseminated to relevant stakeholders who care for and support individuals with IDD at local, provincial and national levels and through publishing findings. By highlighting the disparities in the cancer system and gaps in the research, this scoping review can provide direction for future action.

The evolution of oncology nursing: Leading the path to change

The roles and responsibilities of oncology nurses have rapidly transformed over the past century from general nurses providing bedside comfort care with few technological advances to advanced practice oncology nurses responsible for everything from performing invasive procedures to diagnostic interpretation and screening for cancer prevention. As cancer care continues to evolve, nurses will play a key role in the field of oncology, whether as specialized oncology nurses providing clinical care or as nurse researchers spearheading groundbreaking oncology research.

Évolution des soins infirmiers en oncologie : tracer la voie du changement

Les rôles et responsabilités des infirmières en oncologie ont passablement évolué en cent ans. En effet, les infirmières généralistes, d’abord attitrées aux soins de confort au chevet des patients – et disposant d’une technologie plus limitée –, ont laissé place à des infirmières en pratique oncologique avancée responsables de tout, de l’exécution des procédures invasives à l’interprétation de diagnostics, sans oublier le dépistage pour la prévention du cancer. À mesure que les soins en oncologie continueront d’évoluer, les infirmières seront appelées à jouer un rôle déterminant dans ce champ de pratique, et ce sera vrai tant pour les infirmières spécialisées en oncologie clinique que pour les pionnières de la recherche en oncologie.

Determining the Expected Competencies for Oncology Nursing: A Needs Assessment Study

Background:

A critical component of cancer care, rarely addressed in the published literature, is an expected competency in oncology nursing education. The present text describes an effort to develop cancer-nursing competencies in Iran and the process of the needs assessment.

Materials and Methods:

A 3-phase, mixed-method approach for needs assessment was used, incorporating modified Delphi technique, literature review, interviews, and an expert panel. Different stakeholders, consisting of nurses, faculty members in fields related to oncology nursing education, and patients and their families, participated in different phases of the study. Data were analyzed using manual content analysis.

Results:

In the present study, totally 123 sub-competencies were identified under holistic physical healthcare for patients, psychological and social care, spiritual care, palliative care, ability to prevent at three levels, teamwork and inter-professional competencies, management and leadership competencies, ability to conduct research and evidence-based nursing, supportive care, communication skills, professionalism, provision of education and counselling to patients and their families, and reasoning, problem solving, and critical thinking skills, respectively.

Conclusions:

An updated and applicable list of competencies was extracted, which can be used to design and develop educational programs, which seek to train qualified oncology nurses for an effective nursing care.